8. Introduction of Consideration for Students at University of Tsukuba / 医学教育

The University of Tsukuba aims to be a university where all members, not only LGBT but also everyone with diverse personalities, can share their abilities. The Bureau of Human Empowerment plays a central role in student support in line with the Basic Principles and Guidelines on LGBT+ Inclusion at the University of Tsukuba (2020 revision). Students' gender information is accessible only to those who need it, such as teachers in charge. Faculty and staff are encouraged to handle information carefully. While basic knowledge of LGBT and others is necessary, it is also important to consider all students based on the premise that there are those with diverse personalities who are not LGBT, rather than treating LGBT and other students specially. We shared our opinions with faculty and the faculty development (FD) committee members at FD meetings.

Process of Succession by Family Physicians in Their Family's Clinic: A Qualitative Study / 日本プライマリ・ケア連合学会誌

Introduction: The aim of this study was to clarify the process by which family physicians succeed their parents in their family's clinic and issues that successors experience during this process.Methods: Subjects were certified family physicians in Japan who either succeeded their parents in their clinics or were working regularly at their family's clinic and were planning to succeed their parents. Participants were recruited through a certified family physician mailing list or privately contacted, and participated in a semi-structured individual interview. The text of the interviews was thematically analyzed.Results: Twelve participants were interviewed. All were male. Seven participants succeeded their parents. Family physicians succeeding their parents in their clinics felt implicit expectations towards succession from their family members and communities, which made them think that succession was the goal. They realized that they had no ability to decide on the timing of succession, clinics have customs and continuity, predecessors have different ideas about professionalism, and family businesses are complex. They felt conflict, especially about predecessors, in their emotions towards family members and ideas based on professionalism.Conclusion: We clarified the process of succession by family physicians in their family's clinic, and the issues and conflicts they face during this process.

Introduction of a Social Determinants of Health Education Program into Clinical Clerkship at the University of Tsukuba / 医学教育

The University of Tsukuba School of Medicine introduced an education program on the social determinants of health (SDH). It consists of lectures during the 3rd year and a 4-week family practice and community medicine clerkship between 5th and 6th years. In the clinical clerkship, students receive lectures on the first day, are instructed to consider the SDH in a patient they met during the course, give group presentations and hand in written reports on the last day. Most students were able to analyze patients beyond the biomedical model, but only a few students were able to consider the social background and timeline of each patient. Our future challenge is to enhance students' understanding of SDH through educational programs for faculty members.

Likelihood of Chiikiwaku Medical Student Loan Repayment and Its Associated Factors / 医学教育

This study used a self-administered questionnaire to assess the likelihood of chiikiwaku medical student loan repayment and its associated factors. If chiikiwaku repayment is high, then it can have a negative effect on the chiikiwaku program, which was established to distribute doctors to outlying areas. A total of 112 students (37.8%) reported that the likelihood of repayment was "high" or "somewhat high." The factors statistically associated with repayment likelihood were female gender (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.5-6.8), applying forchiikiwaku mainly due to the higher medical school acceptance rate (OR 2.9, 95%CI 1.2-6.8), private medical school (OR 10.3, 95%CI 2.6-40.3), and stress related to obligation or repayment (OR 2.4, 95%CI 1.3-4.3). The results suggest that to decrease the rate of loan repayment it is important to improve the process of selecting chiikiwaku students and to modify the chiikiwaku system to support students experiencing stress.

Likelihood of Chiikiwaku Medical Student Loan Repayment and Its Associated Factors / 医学教育

This study used a self-administered questionnaire to assess the likelihood of chiikiwaku medical student loan repayment and its associated factors. If chiikiwaku repayment is high, then it can have a negative effect on the chiikiwaku program, which was established to distribute doctors to outlying areas. A total of 112 students (37.8%) reported that the likelihood of repayment was "high" or "somewhat high." The factors statistically associated with repayment likelihood were female gender (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.5-6.8), applying forchiikiwaku mainly due to the higher medical school acceptance rate (OR 2.9, 95%CI 1.2-6.8), private medical school (OR 10.3, 95%CI 2.6-40.3), and stress related to obligation or repayment (OR 2.4, 95%CI 1.3-4.3). The results suggest that to decrease the rate of loan repayment it is important to improve the process of selecting chiikiwaku students and to modify the chiikiwaku system to support students experiencing stress.

Medical Students Learning from a Problem Based Learning (PBL) Style In-home Care Course: A Qualitative Analysis of the Reports / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>The University of Tsukuba has a one-week in-home care course combining a problem-based learning style tutorial and lectures in the comprehensive community-based learning curriculum for 2^nd year students. This study aimed to investigate what medical students are learning concretely from this course.</p><p><b>Methods: </b>We performed a qualitative date analysis of the contents of all 111 student course reports written in the free description using a modified Steps Coding and Theorization method employing the framework of patient-centered clinical method (PCCM).</p><p><b>Results: </b>Medical students learned with keen interest based on their experiences and in the framework of PCCM such as 'Exploring health, disease and the illness experience', 'Understanding the whole person'. These processes led to the awareness of responsibility as a physician.</p><p><b>Conclusion: </b>The in-home care course in the classroom may provide medical students with an opportunity to become aware of their responsibility as a physician.</p>

Patients' impressions about physicians working short-term in community clinics : A qualitative analysis of individual patient interviews / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To reveal patients' impressions of physicians working short-term in community clinics, and to explore methods for physicians to work short-term in community clinics.<br><b>Methods</b> : We conducted a qualitative analysis of recordings of individual interviews performed on patients in community clinics using a partially revised SCAT (Steps for Coding and Theorization) method.<br><b>Results</b> : Patients indicated that they felt reassured by the constant presence of a chief physician at community clinics. They expected care within the scope of primary care, but were not expecting every element within this scope to be met. Patients had the attitude of accepting the current situation and were selecting how to receive medical care from the available options based on their personal priorities.<br><b>Conclusion</b> : Physicians working short-term in community clinics were satisfying a portion of the patients' needs. Providing care within the scope of primary care and taking the initiative in getting to know patients are essential elements for physicians working short-term in community clinics.

How can Japanese University-based Primary Care Physicians Attend International Conferences? / General Medicine

<b>Background: </b>Activity in international conferences is essential for the academic progress of primary care in Japan. We aimed to clarify the obstacles Japanese university-based primary care physicians face in attending and presenting at international conferences.<br><b>Methods: </b>We conducted a questionnaire of 10 residents and 22 physicians in the Department of General Medicine and Primary Care at the University of Tsukuba.<br><b>Results: </b>The primary obstacle preventing conference attendance was English language skills. A secondary obstacle was insufficient time off work.<br><b>Conclusions: </b>Additional support in English language skills and time off work is necessary to promote attendance at international conferences.

Association between smoking prevention education for elementary and junior high school students and modification of their parents' smoking behavior<br>- Can children's talk change parents' behavior? / 日本プライマリ・ケア連合学会誌

Association between smoking prevention education for elementary and junior high school students and the modification of their parents' smoking behavior — Can child education change parental behavior?<br><b>Introduction</b> : This study aimed to investigate an association between a smoking prevention education program for elementary and junior high school students, and the subsequent behavior modifications of their parents.<br><b>Methods</b> : Preventative education programs for smoking were provided to four elementary and three junior high schools in Kamisu City, Ibaraki Prefecture, Japan. We encouraged participating students to discuss the knowledge derived from the education sessions with their families. One month after completing the program, questionnaires were distributed to the parents of the students to investigate whether they had modified their smoking behavior as a result of what they had learnt from their children.<br><b>Results</b> : Two questionnaires were distributed to each of 1109 families, and 1427 valid responses were received. Analysis showed that 794 parents had been informed about tobacco use from their children (55.6%) and 271 parents had modified their smoking behavior (19.0%) as a consequence. This included smoking cessation, decreasing tobacco consumption, and smoking avoidance in the presence of their children. Behavior modification was significantly correlated with the knowledge they had derived from their children based on the preventative smoking education program (odds ratio = 3.3 ; 95% CI : 2.4-4.6).<br><b>Conclusion</b> : Implementation of an education program for smoking prevention focused on elementary and junior high school students can lead to modification of smoking behavior in both students and their parents, respectively.

Influence of parental smoking on junior high school students' perceptions of smoking / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : This study aimed to clarify any associations between familial smoking, especially parental smoking, and high school students' perceptions of smoking.<br><b>Methods</b> : Questionnaires on familial smoking and the Kano Test for Social Nicotine Dependence (KTSND) were distributed to junior high school students. The KTSND is a tool to evaluate positive perceptions of smoking. We analyzed the relationship between the total KTSND score and school grade, gender, familial smoking, paternal smoking, and maternal smoking.<br><b>Results</b> : We received 761 valid responses (valid response rate : 90.4%). Five hundred forty-three students had family members who smoked (71.4%), 394 had smoking fathers (51.8%), and 214, smoking mothers (28.1%). The total KTSND score correlated with familial smoking (10.55 vs 9.46, <italic>p</italic>=0.009) and maternal smoking (11.18 vs 9.87, <italic>p</italic>=0.002).<br><b>Conclusion</b> : Familial smoking, especially maternal smoking, correlated with positive perceptions of high school students towards smoking. Promoting smoking cessation in women with children may be effective in preventing tobacco use among children.

The clinical experience of medical students compared with that of residents / 医学教育

1) We evaluated the clinical experiences of 102 medical students who completed clinical clerkships at the University of Tsukuba, by analyzing their self-assessments on the clinical evaluation form normally used for the postgraduate residency program. <br>2) The medical students participated in the management of a broad range of diseases. However, in most cases, their participation was only partial. <br>3) To improve the continuity between the undergraduate and postgraduate medical education systems, it is important to expand the amount of hands-on participation of medical students in medical practice.

The relationship between medical students' eagerness in clinical clerkships and their interest in medical departments / 医学教育

Medical students must have motivation to participate in medical care during clinical clerkships. How much interest students have in each department might be a factor in making them more active in clerkships. To make clerkships more effective, we performed a questionnaire survey to investigate the relationship between students' interest in each department and their eagerness in clinical clerkships and to investigate factors to increase their eagerness.<br>1) Questionnaires were distributed to 92 sixth-year medical students at the University of Tsukuba. The questionnaire consisted of 6-point Likert scales of 4 specific student attitudes in clerkships. We asked the same questions about clerkships at medical departments that each student found more or less interesting.<br>2) We asked the students to report anecdotes about when they were motivated to learn more in the clerkships. We grouped similar answers into categories.<br>3) The response rate was 94%. The students were more eager in departments they found more interesting than in departments they found less interesting.<br>4) Thirty-eight students reported a total of 56 anecdotes. Among the categories, questions or words of encouragement from patients were mentioned in 29 anecdotes, and devoted faculty members were mentioned in 9 anecdotes.<br>5) These results suggest that medical students' eagerness in clinical clerkships could be increased by deepening their interest in medical departments and by improving communication with patients and physicians.

Impressions of medical students and patients of an outpatient escort program for first-year medical students / 医学教育

We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.<BR>1) A questionnaire was distributed to all participating patients and students in 2006.<BR>2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.<BR>3) Results of the questionnaire showed that both students and patients rated this program highly.<BR>4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.<BR>5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.

Effect of a Community-based Interprofessional Education Program for Healthcare Students in Japan / 医学教育

To provide appropriate healthcare services to all patients, strong interprofessional partnerships are essential. We have developed a voluntary community-based interprofessional education (IPE) program for medical students and other healthcare students. In this program, students from different healthcare fields conduct fieldwork together in small groups. The purpose of this study was to determine what participants learned through the IPE program.<BR>1) Five researchers with different healthcare backgrounds analyzed all (63) participants' postprogram reports (collected since 2002) and extracted and categorized items describing what the participants had learned.<BR>2) The categories of items learned included the roles of healthcare professionals, cooperation among healthcare professionals, the meaning of “community medicine”, the difficulty and the importance of communication, and a sense of fellowship with participants of other backgrounds.<BR>3) These items indicate our IPE program helps students learn about interprofessional cooperation by observing actual examples of cooperation in the community and by working with students from different healthcare fields.

An Outpatient Escort Program for First-year Medical Students as Early Exposure Training / 医学教育

We conducted an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorted one patient at the University of Tsukuba Hospital throughout his or her first visit. This program enabled the students to experience and think about the system of a university hospital from a patient's point of view. We believe that this program is useful to motivate first-year medical students in their future studies.

What does the General Public Think Residents can Do?: Exploratory Research on Layperson's Perceptions of Residents' Clinical Competence / 医学教育

This study explored the general public's perception of the clinical competence of residents. Methods: Individual interviews of laypersons, medical students, and residents and focus-group interviews of residents were conducted. Results: Individual interviews revealed the belief that residents acquired various clinical skills immediately after passing the national examination for medical practitioners. These skills included: assessment of the need for referrals, on-call jobs for after-hours and emergency services, interpreting X-ray films, performing cardiopulmonary resuscitation, performing surgery for appendicitis, and treating bone fractures and joint dislocations. Focus-group interviews revealed differences between residents and laypersons in the perception of residents' clinical skills. These skills included: general knowledge of diseases and medications, guidance about lifestyle after discharge, physical examinations, explanation of treatment, diagnostic imaging, and knowledge of or expertise in other medical professions. Conclusion: Laypersons and medical personnel have different perceptions about the clinical competence of residents.

Opinions of Japanese Medical Students on the Necessity of Experience in Community-based Learning Programs / 医学教育

We conducted a questionnaire survey of all sixth-year students at 10 Japanese medical schools asking their opinions on the necessity of experience in community-based learning (CBL) programs. We developed a detailed questionnaire to examine students' experiences in CBL and their opinions of its necessity using the students' reports from CBL by Delphi process. After excluding data from 1 medical school because of a low response rate, we analyzed data from 659 students (response rate, 75%). The necessity of each item in the required programs, except “seeing labor in medical facilities, ” was more likely to be recognized by students who had experienced the item than by students who had not experienced it. The differences between experiencing and nonexperiencing students in recognizing necessity were greatest for “conversation with patients in their homes, ” “seeing physicians' consultation or referral to other medical institutions, ” “observing nurses work in the outpatient clinic, ” and “participation in conferences with various professional staff.” These results suggest that medical students can recognize the significance and meaning of CBL through experience.

A Study of Support Systems for Women in Medicine: Dual Roles of Professional and Mother / 医学教育

We examined issues in balancing professional obligations with family needs, especially parenting, in female physicians. Questionnaires were given to all female physicians who had graduated from Jichi Medical School. Of the 196 graduates, 155 responded (79.1%), and younger graduates accounted for a greater proportion of subjects. Although many female physicians did not live with their parents, female physicians or their parents were usually responsible for caring for children when they become ill. Many respondents demanded better access to day care and greater flexibility in accepting sick children. Female physicians should contribute to society using the knowledge and skills they acquired in medical school; to do so they need support systems in their workplace and child-care services.

Nationwide Survey of Primary Care Curricula for Undergraduate Medical Students in Japan / 医学教育

We conducted a nationwide survey to examine the primary care (PC) curricula for undergraduates at Japanese medical schools. The present status of PC curricula and the degree of recognition of the need for improvement were examined. Seventy (88%) of the medical schools in Japan responded. PC education programs have been organized and are carried out by various departments in each school. Of the 69 medical schools, 42% have a PC education program with lectures to teach the role of PC physicians, 65% have a program to provide experience in community medical care, and 80% have programs to provide experience in health care institutions and welfare facilities. Although the number of schools with lectures and experience programs for PC has increased at least three-fold in the past decade, many medical school presidents (more than 60%) recognize PC education should be improved. By comparing medical schools with and without experience programs in clinic more presidents of schools without such programs recognized the need to improve PC education.